Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 167473 | NY |
NPI | 1013920487 |
---|---|
Provider Name | Dr. Yan Shin Tan |
First Address | Staten Island, NY 10312-4515 |
Second Address | New York, NY 10012-4553 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/08/2006 |
Last Update Date | 08/07/2007 |